Tanaka Yutaka, Sugihara Marie, Tsumagari Shuntaro, Takamatsu Nobue, Kurihara Kazuyuki
Department of Allergy, Kanagawa Children's Medical Center.
Beppu University Faculty of Food Science and Nutrition.
Arerugi. 2017;66(8):1011-1015. doi: 10.15036/arerugi.66.1011.
A 12-year-old girl was referred to our hospital owing to repeated anaphylactic reactions induced by exercise after meals. Food-dependent exercise-induced anaphylaxis (FDEIAn) was suspected. However, sequential tests of typical foods, including egg, milk, soy, and wheat, in combination with exercise, were all negative.The results of the skin prick test (SPT) for Citrus unshiu and specific IgE test for orange and grapefruit were positive. Although no symptoms were noted after an exercise challenge combined with the ingestion of only Citrus unshiu, an anaphylactic reaction was induced by additional acetyl-salicylic acid. From these results, she was diagnosed with FDEIAn due to the ingestion of Citrus unshiu. Because the SPT results for other citrus fruits (including orange, grapefruit, lemon, yuzu, sudachi, ponkan, and iyokan) were all positive, it was suggested that these fruits demonstrate cross-reactivity with each other. Since the girl eliminated citrus fruits from her diet, she has not developed any anaphylactic symptoms. Citrus fruits are not known to cause FDEIAn, but the findings of this case suggest that it is necessary to recognize them as a causative allergen of FDEIAn.
一名12岁女孩因餐后运动反复诱发过敏反应而转诊至我院。怀疑为食物依赖运动诱发过敏反应（FDEIAn）。然而，对包括鸡蛋、牛奶、大豆和小麦在内的典型食物进行的连续运动激发试验均为阴性。温州蜜柑的皮肤点刺试验（SPT）以及橙子和葡萄柚的特异性IgE检测结果均为阳性。虽然仅摄入温州蜜柑后进行运动激发试验未出现症状，但额外服用乙酰水杨酸会诱发过敏反应。根据这些结果，她被诊断为因摄入温州蜜柑导致的FDEIAn。由于其他柑橘类水果（包括橙子、葡萄柚、柠檬、柚子、酸橘、椪柑和伊予柑）的SPT结果均为阳性，提示这些水果之间存在交叉反应性。自从该女孩从饮食中排除柑橘类水果后，她未再出现任何过敏症状。此前并不认为柑橘类水果会导致FDEIAn，但该病例的研究结果提示，有必要将其视为FDEIAn的一种致病过敏原。
